Monthly Archives: November 2015

The use of both over-the-counter and prescription nonsteroidal medications is frequently recommended in a typical neurosurgical practice. But persistent long-term use safety concerns must be considered when prescribing these medications for chronic and degenerative pain conditions. This article is a literature review of the biochemical pathways of inflammatory pain, the potentially serious side effects of nonsteroidal drugs and commonly used and clinically studied natural alternative anti-inflammatory supplements. Although nonsteroidal medications can be effective, herbs and dietary supplements may offer a safer, and often an effective, alternative treatment for pain relief, especially for long-term use.

BACKGROUND: No previous studies have created and validated prediction models for outcomes in patients receiving spinal manipulation for care of chronic low back pain (cLBP). We therefore conducted a secondary analysis alongside a dose-response, randomized controlled trial of spinal manipulation.

METHODS: We investigated dose, pain and disability, sociodemographics, general health, psychosocial measures, and objective exam findings as potential predictors of pain outcomes utilizing 400 participants from a randomized controlled trial. Participants received 18 sessions of treatment over 6-weeks and were followed for a year. Spinal manipulation was performed by a chiropractor at 0, 6, 12, or 18 visits (dose), with a light-massage control at all remaining visits. Pain intensity was evaluated with the modified von Korff pain scale (0-100). Predictor variables evaluated came from several domains: condition-specific pain and disability, sociodemographics, general health status, psychosocial, and objective physical measures. Three-quarters of cases (training-set) were used to develop 4 longitudinal models with forward selection to predict individual “responders” (≥50% improvement from baseline) and future pain intensity using either pretreatment characteristics or post-treatment variables collected shortly after completion of care. The internal validity of the predictor models were then evaluated on the remaining 25% of cases (test-set) using area under the receiver operating curve (AUC), R(2), and root mean squared error (RMSE).

A recent report from the RAND Corporation describes how regular medicine reduced complementary and alternative medicine professionals to “thing” status — as “modalities” — in the first years of the integrative medicine era.

The title of the report is “Complementary and Alternative Medicine: Professions or Modalities?” The discussions among policy makers, practitioners and delivery system leaders synthesized in the 75-page document beg a more significant question: Does the emergence of values-based medicine urge a major re-think regarding the potential contributions of these professionals?

The case statement by RAND’s Patricia Herman, ND, PhD and Ian Coulter, PhD begins with a blunt irony. “One of the hallmarks of complementary and alternative medicine (CAM) is treatment of the whole person.” Yet in the fee-for-service procedure and production orientation of the medical industry, licensed practitioners of chiropractic, acupuncture and Oriental medicine, and naturopathic medicine were typically stripped of this core value — treating the whole person — before being put to any use.

Regular medicine’s dominant influence when “CAM” integration by medical delivery organizations began in the mid-1990s was the industrial value of service production. Mayo Clinic’s director of innovation captures this concisely when he recently spoke of medicine’s historic focus on “producing” services rather than on “creating health.”

In such an industrial setting, a chiropractor became a thing to be use sparingly. Chiropractor = spinal manipulation for low back pain.

A precedent for this boiling down of a chiropractor’s potential value in human health to thing status was set for chiropractors decades earlier in Medicare. In that even more intransigent fee-for-service era, only adjustment of the spine for low back pain made the grade. Unremunerated was the time that a chiropractor spends in evaluation and management. Most of the chiropractic professional’s education and practice rights were dumped overboard. No value was placed on a chiropractor’s counseling of patients on diet, lifestyle, dietary supplements, or ergonomics, for instance.

Getting into Medicare at all back then was a victory for the field. But a consequence of this limited economic relationship was the rack ’em and crack ’em – as fast as possible method of treatment. Produce!

Breast Cancer and Chiropractic

Regional Director of Chiropractic for the
Cancer Treatment Centers of America

Well known celebrities discussing their personal challenges with breast cancer has led to frequent media coverage. Primarily, the focus is on the oncological decisions regarding treatment: whether to have radical surgery along with chemo and radiation, just radiation or take a holistic approach. However, there isn’t much attention drawn to Quality of Life (QoL) factors that parallel the breast cancer patient experience.

In other words, treatment decisions and outcomes often seem to shadow the collateral damage experienced by patients who undergo conventional breast cancer treatment. Many premenopausal women face the inevitable decision to take the drug tamoxifen to help prevent recurrence of the disease at the risk of having menopausal-like symptoms. Also, reconstructive post-mastectomies can lead to complications during the healing process and beyond. These complications may include poor wound healing at the site of reconstruction, as well as the tissue donor site. Frozen shoulder is a common occurrence for post-mastectomy, breast reconstruction patients. Many breast cancer patients are forced to look outside their core oncology team to find services that will help with QoL.

It was reported in the Journal of Clinical Oncology that among 453 cancer patients surveyed, 83.3 percent had used at least one complementary alternative medicine (CAM) therapy concurrent with conventional treatment. Another discovery was that 24.7 percent of participants used seven or more CAM therapies. [1]

Clinical features: 23-month-old female presenting with 6 acute otitis media episodes since the age of 6 months. Parents are alerted to otitis media symptoms when the child pulls on the ear and cries. Current allopathic treatment consists of antibiotic therapy but episodes of otitis media are still recurrent.

Intervention and outcomes: The patient received 6 full spine diversified chiropractic adjustments with myofascial release of cervical muscles and effleurage of the frontal and maxillary sinuses over the course of one month. Treatment protocol was then changed to 1 visit per 2 weeks, 1 visit per month and lastly, prevention visits at 1 visit per 2 months or whenever the patient presented with cold symptoms. During the year following the first chiropractic treatment, the patient continued chiropractic care every two months and has had no reoccurrence of AOM.

Developmental Advancements Following Chiropractic Care in a Four-year-old Child With Dyspraxia and Associated Developmental Delays: A Case Report

1. Senior Intern,
New Zealand College of Chiropractic,
Auckland, New Zealand

2. Lecturer and Intern Mentor,
New Zealand College of Chiropractic,
Auckland, New Zealand

Objective: To present the chiropractic management of a 4-year-old child diagnosed with dyspraxia and concomitant vertebral subluxations.

Clinical Features: A four-year-old boy with a history of developmental motor delays was presented by his mother for chiropractic evaluation. The child was previously diagnosed with dyspraxia at one year of age, based on a delay in developmental milestones being met; specifically of speech and fine motor control. The patient was 1.25-years-old before starting to walk and 3-years-old before being able to produce any basic sounds such as “Ma” or “Da”.

At the commencement of chiropractic care the child was undergoing concomitant speech therapy; six weeks of intensive repetitive therapy was the average amount of time required for the patient to learn and retain one new sound or word.

Intervention: Modified Diversifed (Touch-and-hold) and Sacro-Occipital Techniques were utilized to reduce subluxation indicators through the cranium, upper cervical and lumbopelvic spine. Fifteen adjustments were administered over a 4-month period.

Outcome: The child experienced a number of developmental advancements over the duration of chiropractic care, specifically in speech, fine motor control and coordination. After 8 visits the patient learned 20 new words in one week, after 12 visits all primitive reflexes were tested to be within normal limits and after 15 visits their vocabulary consisted of hundreds of words and continued to expand.